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    Research Grants Awarded

    Behavior Activation for Depressed Cancer Patients: Randomized Trial

    Study Section:
    Treatment

    Scientific Abstract:
    Background: Depression is a significant mental health problem among breast cancer patients and is associated with impairment in recreational activities, social life, family relationships, self-care skills, physical activities, and sleep. Depressed breast cancer patients also experience more rapidly progressing cancer symptoms and more metastasis and pain than non-depressed patients. Although there has been some psychosocial treatment outcome research among breast cancer patients, this research has major limitations in that individuals with well-diagnosed depression have not been studied, selective samples have been used, outcome measures are non-comprehensive, and we know little about predictors of response to psychological treatment. Objective/Hypothesis: Preliminary data indicate a brief behavioral activation treatment for depressed cancer patients (BATD-C; XXXX et al., 2005, 2006) may represent an effective and viable medical care intervention to reduce depression in breast cancer patients, increase quality of life, and improve medical outcomes such as decreased pain and improved social functioning. Specific Aims: (1) examine the efficacy of BATD-C with breast cancer patients in a medical care setting, where depression often is undiagnosed and under-treated, (2) examine whether BATD-C + Usual care (UC) is more effective than supportive therapy (ST) + UC in a medical care environment (at post-treatment through 12-month follow-up), and (3) examine demographic, clinical, and medical predictors (e.g., cancer-specific variables) of positive treatment outcome among depressed breast cancer patients. Study Design: 80 breast cancer patients with major depression will be randomly assigned to BATD-C + UC or ST + UC. All patients will be treated in a medical care setting. Clinical outcomes assess symptoms of depression and anxiety. Functional outcomes assess medical outcomes, social support and quality of life. Satisfaction outcomes assess patient satisfaction with BATD-C and ST. Service utilization will encompass frequency of visits for physical/emotional problems, frequency of referrals for mental health care, and medication use. Long-term effects of treatment are assessed over 12-months. Potential Outcomes and Benefits of Research: The study will resolve many methodological limitations of outcome research for depressed breast cancer patients and examine the efficacy of a promising intervention in a medical care setting. In doing so, our primary mission is to evaluate a time-efficient and practical intervention that may reduce the negative impact of depression and improve quality of care and longevity of life for breast cancer patients with depression.

    Lay Abstract:
    About 30-40% of breast cancer patients are clinically depressed. Among depressed breast cancer patients, significant deterioration is evident in recreational and physical activities, social life, family relationships, self-care skills, and sleep. Depressed breast cancer patients also experience more rapidly progressing cancer symptoms and more metastasis and pain than non-depressed patients. Although there has been some psychosocial treatment outcome research among breast cancer patients, this research has major limitations in that individuals with well-diagnosed depression have not been studied, selective samples have been used, outcome measures are non-comprehensive, and we know little about predictors of response to psychosocial treatment. In fact, in none of the outcome studies conducted, except for two preliminary studies by our research team (XXXX et al., 2005, 2006), have researchers specifically targeted cancer patients with well-diagnosed depression. Therefore, we do not know whether positive effects of psychosocial interventions extend beyond non-clinical (subsyndromal) samples toward clinically depressed patients, a population more difficult to treat. Therefore, researchers must continue to develop and examine the effectiveness of psychological interventions toward decreasing depression and increasing quality of life for breast cancer patients. This proposal builds on preliminary data that indicate a brief behavioral activation treatment for depressed cancer patients (BATD-C; XXXX et al., 2005) may effectively reduce depression, increase quality of life, and improve medical outcomes such as decreased pain and improved physical functioning (XXXX et al., 2005, 2006). The proposal aims to examine: (1) the utility of BATD-C with breast cancer patients in a medical setting, where depression is under-treated, (2) whether BATD-C + usual care (UC) is more effective than supportive therapy (ST) + UC and, (3) demographic, clinical, and medical predictors (e.g., cancer-specific variables) of positive treatment outcome. Outcome measures include clinical outcomes of depression and anxiety. Functional outcomes assess medical status, social support and quality of life. Satisfaction outcomes assess patient satisfaction with BATD-C and ST. Service utilization encompasses frequency of visits for physical/emotional problems and medication use. Long-term effects of BATD-C and ST are assessed over 12-months. Our goal is to improve quality of care and longevity of life for depressed breast cancer patients through efficient interventions like BATD-C.